Use of vacuum-assisted closure for management of a large skin wound in a cat

CASE DESCRIPTION: A 9-month-old domestic shorthair cat was evaluated after being struck by a car. CLINICAL FINDINGS: The cat had a fractured tibia and avulsion of the tail base. Motor and deep pain sensation were absent from the tail. The fractured tibia was repaired 2 days after the trauma. On the third day, the cat developed tachypnea, dyspnea, high serum urea nitrogen and total bilirubin concentrations, epistaxis, persistent hypotension, and oliguria. The cat recovered with supportive care but developed extensive necrosis of the skin on the dorsum by 9 days after the initial trauma. TREATMENT AND OUTCOME: The skin was debrided from the caudal portion of the scapula to the anus and down each pelvic limb to the level of the distal portion of the femur. The tail was amputated. Wet-to-dry bandages were applied to the wound for 3 days. Approximately 50% of the wound underwent delayed primary closure, and the remainder was managed with vacuum-assisted closure. A healthy granulation bed was quickly established. Vacuum-assisted closure was also applied after graft application. Graft acceptance was 100%, and use of the vacuum-assisted closure bandage was not associated with the complications associated with the traditional bandage. CLINICAL RELEVANCE: Vacuum-assisted closure is a useful, easily applicable technique for open and grafted wounds, even when wounds are in challenging anatomic locations.     

Necrotising fasciitis associated with Escherichia coli in a dog

CASE HISTORY: Lameness and limb pain associated with a laceration in the inner thigh of a Border Collie dog progressed over 4 days to extensive necrosis of the full-thickness of skin and subcutaneous (S/C) tissue. A successful outcome was achieved using surgical debridement and intensive supportive care, followed by limited local closure, axial pattern flap development, and free skin grafting. CLINICAL FINDINGS: Clinical findings included severe pain, depression, pyrexia and hypoalbuminaemia, and full-thickness loss of skin from the caudal thigh to the hock. Histopathologically, debrided tissue showed extensive necrosis of the dermis, adipose and muscle tissues, and the presence of numerous Gram-negative rods. Escherichia coli was cultured from deep tissue samples. DIAGNOSIS: Necrotising fasciitis (NF) associated with E. coli infection. CLINICAL RELEVANCE: NF associated with E. coli has not been previously reported in dogs. The importance of early diagnosis and surgical debridement is noted and the relevant medical literature is reviewed.     

Comparison of equine amnion and a nonadherent wound dressing material for bandaging pinch-grafted wounds in ponies

OBJECTIVE: To evaluate healing of pinch-grafted wounds on the distal aspect of the limbs of ponies bandaged with equine amnion or a standard nonadherent wound dressing material. ANIMALS: 6 ponies. PROCEDURE: A 2.5x2.5-cm full-thickness section of skin was removed from the dorsal aspect of each limb at the midpoint of the metacarpus or metatarsus. Six days later, wounds were grafted with partial-thickness pinch grafts. Half the wounds were bandaged with amnion, and the other half were bandaged with a nonadherent dressing. Bandages were changed every 3 days until wound healing was complete. At each bandage change, numbers of grafts lost were recorded, and wounds were measured. RESULTS: Percentage of grafts lost from wounds bandaged with amnion was not significantly different from percentage lost from wounds bandaged with the nonadherent dressing. Median healing time for wounds bandaged with amnion (30 days) was significantly less than median healing time for wounds bandaged with the nonadherent dressing (39 days). All wounds were healed by day 45. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that amnion can be used for bandaging pinch-grafted wounds on the distal aspect of the limbs of ponies.     

The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs

Objective— To evaluate clinical outcome after vacuum-assisted closure (VAC) therapy in dogs with traumatic wounds located in the distal extremities and report our early experience with VAC.
Study Design— Retrospective study.
Animals— Dogs (n=15) with traumatic distal extremity wounds.
Methods— Medical records (1999–2003) of dogs with traumatic injuries to the distal extremities managed by VAC were evaluated. Data included signalment, location of wound, time until surgical intervention, wound reconstruction methods, orthopedic procedures, outcome, complications associated with VAC, and length of hospitalization.
Results— The mean number of days until reconstruction was 4.6 days (range, 2–7 days). Reconstructive surgery was successful in all cases. Mean hospitalization was 9.7 days (range, 6–16 days). Complications included dermatitis at the wound margin and loss of vacuum causing wound desiccation.
Conclusion— VAC therapy can be used to achieve adequate management of traumatic distal extremity wounds. VAC provides an effective method of securing skin grafts over the wound bed.
Clinical Relevance— VAC therapy can be used as an ancillary treatment for distal extremity wounds in dogs before surgical repair as well as a method for securing skin grafts to the wound bed.     

Necrotising fasciitis associated with Escherichia coli in a dog

CASE HISTORY: Lameness and limb pain associated with a laceration in the inner thigh of a Border Collie dog progressed over 4 days to extensive necrosis of the full-thickness of skin and subcutaneous (S/C) tissue. A successful outcome was achieved using surgical debridement and intensive supportive care, followed by limited local closure, axial pattern flap development, and free skin grafting.

CLINICAL FINDINGS: Clinical findings included severe pain, depression, pyrexia and hypoalbuminaemia, and full-thickness loss of skin from the caudal thigh to the hock. Histopathologically, debrided tissue showed extensive necrosis of the dermis, adipose and muscle tissues, and the presence of numerous Gram-negative rods. Escherichia coli was cultured from deep tissue samples.

DIAGNOSIS: Necrotising fasciitis (NF) associated with E. coli infection.

CLINICAL RELEVANCE: NF associated with E. coli has not been previously reported in dogs. The importance of early diagnosis and surgical debridement is noted and the relevant medical literature is reviewed.     

Cutaneous wound healing in the cat: a macroscopic description and comparison with cutaneous wound healing in the dog

OBJECTIVE: To describe the macroscopic features of first and second intention cutaneous wound healing in the cat and compare with the dog. STUDY DESIGN: Experimental study. ANIMALS: Domestic shorthaired cats (6) and beagle dogs (6). METHODS: Square, open cutaneous wounds created on the dorsal aspect of the thorax were evaluated for 21 days for temporal and spatial development of granulation tissue, wound contraction, epithelialization, and total healing. To evaluate first intention healing, breaking strength of sutured linear cutaneous wounds was measured at 7 days post-wounding. Laser-Doppler perfusion imaging was used to measure cutaneous perfusion. RESULTS: First intention healing: sutured wounds in cats were only half as strong as those in dogs at day 7 (0.406 versus 0.818 kg breaking strength). Second intention healing: cats produced significantly less granulation tissue than dogs, with a peripheral, rather than central distribution. Wound epithelialization and total wound healing (total reduction in open wound area from contraction and epithelialization) were greater for dogs than for cats over 21 days. Wound contraction on day 7 was greater for dogs, but not on day 14 or 21. Cutaneous perfusion was initially greater for dogs than for cats, but no differences were detected after day 7. CONCLUSIONS: Significant, previously unreported differences in cutaneous wound healing exist between cats and dogs. In general, cutaneous wounds in cats are slower to heal. Cats and dogs also appear to use different mechanisms of second intention healing. In cats wounds close mainly by contraction of the wound edges, whereas in dogs wounds close more from central pull, and epithelialization. CLINICAL RELEVANCE: Surgeons should view the cat as a unique species, which presents its own special challenges in wound healing, and should take this into account when planning treatment of feline wounds, either by primary closure, or by second intention healing.     

Omental pedicle used to manage a large dorsal wound in a dog

An eight-year-old miniature schnauzer was presented with full thickness skin necrosis over most of the back, probably caused by a chemical burn. Management consisted of debridement, bandaging, hyperbaric oxygen therapy, topical application of tris-EDTA and oral administration of antimicrobials. A pedicle created from the greater omentum was used to fill the wound and provide a vascular bed for a full thickness meshed skin graft. Despite epidermal loss from the majority of the graft, the wound healed with acceptable appearance and function. This is the first clinical case described in the veterinary literature using an omental pedicle to prepare a free skin graft bed.     

Case Report: Use of a nanocrystalline silver dressing and vacuum‐assisted closure in a severely burned dog

Objective – To describe the first veterinary use of a nanocrystalline silver dressing (NSD) and use of vacuum‐assisted closure (VAC) to treat a severely burned dog. Case or Series Summary – A 1‐year‐old female intact American Staffordshire Terrier with 50% total body surface area burned was referred for definitive care approximately 18–24 hours post injury. The dog was treated with crystalloid fluids, hydroxyethyl starch, and antimicrobials based on culture and sensitivity results of wound cultures, fresh frozen plasma, human serum albumin, and packed red cells. Wound care initially consisted of daily debridement under anesthesia with silver sulfadiazine application and bandaging. Because of the extent and the location of the wounds and morbid state of the patient, early wound grafting was not an option. Because of its reported improvement in granulation tissue formation and decreased tissue edema, VAC was used once the majority of burned tissue was manually debrided. Because of the pain caused by VAC and traditional bandaging techniques with this extent of injury, an NSD was utilized. This strategy was chosen due to the antimicrobial properties of NSD and the reduced necessity for daily bandage changes, which was reduced to only every 3 days. This protocol reduced the need for daily sedation or anesthesia. New or Unique Information Provided – VAC and NSD were used successfully for the treatment of a severe burn injury in a dog. The use of NSD decreased the cost of therapy by reducing the need for daily bandage changes, thereby reducing the anesthetic and analgesic costs and allowing the patient to be managed on an outpatient basis.     

Effects of topical application of antimicrobials and bandaging on healing and granulation tissue formation in wounds of the distal aspect of the limbs in horses

OBJECTIVE: To determine whether povidone iodine ointment or 2 forms of silver sulfadiazine applied topically to wounds of the distal aspect of the limbs in horses affect the rate of second intention healing and to evaluate the additional influence of bandaging with these antimicrobials on granulation tissue formation. ANIMALS: 6 healthy adult horses. PROCEDURE: Six standardized 2.5-cm2 skin wounds/horse were distributed between the dorsomedial surfaces of the metacarpi and metatarsi. One of the following 6 treatments was applied to each wound: 1% silver sulfadiazine cream with bandage, 1% silver sulfadiazine slow-release matrix with bandage, 1% silver sulfadiazine slow-release matrix without bandage, povidone-iodine ointment with bandage, untreated control with bandage, and untreated control without bandage. Wound area, granulation tissue area, and perimeter were measured by use of planimetry software applied to digital images. Exuberant granulation tissue was excised when present. Days until healing, rate of healing parameter, rate of contraction, and epithelialization were compared among wound treatment groups. RESULTS: Healing parameters and mean days to healing did not differ significantly among any of the wound treatment groups. Percentage wound contraction and rate of epithelialization were similar among wound treatments. All bandaged wounds produced exuberant granulation tissue, which was surgically excised; none of the unbandaged wounds produced exuberant granulation tissue. CONCLUSIONS AND CLINICAL RELEVANCE: When exuberant granulation tissue is removed, rates of epithelialization and wound contraction were not different among wound treatment groups, whether bandaged or unbandaged. Topical application of 1% silver sulfadiazine slow-release matrix on unbandaged wounds induced the same result as medications applied beneath bandages, but without exuberant granulation tissue formation.     

Negative-Pressure Wound Therapy as Management of a Chronic Distal Limb Wound in the Horse

Wound healing in distal limb wounds with tissue loss in horses may be an expensive and long process due to prolonged inflammatory phase. Negative pressure wound therapy (NPWT) (also known as vacuum-assisted closure) is well established method of wound therapy in human plastic and reconstructive surgery for many years. It consists of a leak free bandage and a pump that applies subatmospheric pressure to the wound area. This report describes the successful use of the NPWT intended for the suppression of exuberant granulation tissue development of the wound on distal limb in a horse.     

Superficial Osteitis and Sequestrum Formation as a Result of Skin Avulsion in the Horse

Metatarsal injuries with exposed bone are described in seven horses. Superficial osteitis and sequestrum formation occurred in six of the seven horses. The basic pathophysiology includes local vascular stasis leading to ischemic necrosis of osteocytes and establishment of bacterial infection within dead bone. Radiographic features of superficial osteitis and sequestrum formation include reactive periosteal new bone formation, an area of radiodense necrotic bone (sequestrum) surrounded by a radiolucent zone of granulation tissue, which in turn, is surrounded by an area of increased radiodensity (involucrum). The presence of a sequestrum may usually be confirmed radiographically by 12–14 days after injury. Surgical management included wound debridement, wound irrigation, bandaging or casting, sequestrectomy and skin grafting. Five of the seven patients required sequestrectomy, in one the sequestrum disappeared without removal. Mixed bacterial populations were commonly found in the wounds. No specific etiologic agent was associated with sequestrum formation.     

Large trunk wounds.

Management of large trunk wounds begins with good wound management and bandaging. When a healthy wound bed exists and adequate tissue is present, the wound is closed. Fortunately, there is an abundance of loose trunk skin in most animals, and wound closure can be accomplished by simple reconstructive techniques, such as undermining and tension or "walking sutures." Nevertheless, some wounds and areas of the torso may require more advanced tension-relieving techniques, skin stretching, and tissue implants or flaps to achieve tension-free closure and successful wound healing. Use of these techniques allows wound closure and good cosmetic results for even those wounds that initially may seem foreboding.     

The effect of topical tripeptide-copper complex on healing of ischemic open wounds

OBJECTIVE: To evaluate the effects of topical glycyl-L-histidyl-L-lysine tripeptide-copper complex (TCC; Iamin 2% Gel; Procyte Corporation, Redmond, WA) on healing in ischemic open wounds. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Twenty-four adult male Sprague-Dawley rats. METHODS: Rats were divided into 3 groups: topical TCC, topical TCC vehicle (hydroxypropyl-methylcellulose), and no treatment (control). Six-mm-diameter, full-thickness wounds were created within an ischemic bipedicle skin flap on the dorsum of each rat. Each day, for 13 days, wound margins were traced, and the TCC and TCC vehicle groups were treated topically. Tracings were scanned, and wound perimeter and area were calculated. On days 6, 10, and 13, selected wounds were biopsied and analyzed for tumor necrosis factor alpha (TNF-alpha) and matrix metalloproteinases (MMP) 2 and 9. RESULTS: A significant decrease in wound area was seen in the TCC group, but not the vehicle group, when compared with the control group on days 3 to 5, 6 to 9, and 11 to 13 and when TCC was compared with TCC vehicle on days 3 and 9. On day 13, initial wound area had decreased by 64.5% in the TCC group, 45.6% in the vehicle group, and 28.2% in the control group. On days 6, 10, and 13, TCC-treated wounds contained significantly lower concentrations of TNF-alpha and MMP-2 and MMP-9 than control wounds. CONCLUSION: Topical TCC resulted in accelerated wound healing in ischemic open wounds. CLINICAL RELEVANCE: Topical TCC is an effective stimulant of healing of ischemic open wounds in rats and may have an application for the treatment of chronic wounds in other species. Clinical evaluation of topical TCC is warranted.     

Ultrasound therapy for the prevention and correction of contractures and bone mineral loss associated with wing bandaging in the domestic pigeon (Columba livia).

Figure-of-eight wing bandaging is widely used to treat wing injuries, to immobilize wings before and after fracture repair, and during transient wing paralysis. However, prolonged bandaging can lead to bone loss and to contractures and reduced range of joint motion. Studies evaluating the efficacy of therapeutic ultrasound to reverse and prevent bandaging-associated contractures in pigeons (Columba livia) showed a significant increase in elbow and carpal extension after 10 twice weekly ultrasound treatments when started either 4 or 11 days after bandage placement. In addition, after 42 days of wing bandaging, three ultrasound treatments stimulated a faster reversal of carpal wing rotation loss than removal of the bandage over the 10-day treatment period. Finally, bone loss in response to 28 days of bandaging was significant, progressed at 2.8% per week, and was not affected by ultrasound treatment twice weekly during this period. Therefore, therapeutic ultrasound prevented and reversed loss of wing extension associated with figure-of-eight bandaging but did not lessen the disuse osteoporosis created by bandaging in these birds.     

Evaluation of a collagen patch as a method of enhancing ventriculotomy healing in Japanese quail (Coturnix coturnix japonica)

OBJECTIVE: To assess the ability of a porcine submucosal collagen patch to enhance ventriculotomy healing in quail. STUDY DESIGN: Histologic assessment of wound repair after ventriculotomy. Animal Population-Eighteen adult Japanese quail. METHODS: All quail had a ventriculotomy through the caudoventral thin muscle. The quail were randomly assigned to 1 of 2 groups: group I (n = 9) had routine closure and group II (n = 9) had routine closure and the application of a porcine submucosal collagen patch over the serosal surface of the ventricular suture line. Three quail from each group underwent necropsy at 7, 14, and 21 days after surgery and healing of the ventriculotomy site was evaluated by microscopy. RESULTS: Ventricular mucosal epithelium was completely healed at 21 days postoperatively. Time to restoration of the ventricular submucosal integrity was variable in both groups. There was evidence of a gross or microscopic perforation in 4 quail in group II, which was statistically significant (P =.041). Quail with perforations had significantly elevated numbers of ventricular serosal lymphoid aggregates compared with those without perforations (P =.029). There were no other significant temporal differences between group I and group II for mortality or histopathologic grading of wound healing. CONCLUSIONS: A porcine collagen patch did not enhance ventriculotomy wound healing. Subjectively, the collagen patch might have contributed to perforation by the generation of a lymphocytic xenograft rejection response. CLINICAL RELEVANCE: Ventriculotomy can be safely performed using routine closure methods in healthy birds.     

Sequential measurements of the tibial plateau angle in large-breed, growing dogs

OBJECTIVES: To determine the earliest age that canine tibial plateau angles (TPAs) can be reliably measured and determine whether TPAs change during long bone growth. ANIMALS: 10 Labrador Retrievers and 20 Labrador Retriever-hound crossbreeds. PROCEDURE: Stifle joints were radiographed every 2 months from 8 weeks of age to radiographic closure of the tibial physes. Four examiners radiographically evaluated TPA, physeal closure status (ie, complete or incomplete) of the proximal and distal tibial physis, and whether anatomic TPA measurement landmarks were sufficiently visible (LSV) or insufficiently visible (LIV) for accurate measuring. Linear regression analysis was performed to detect change in TPAs over time. Mean ages with 95% confidence intervals (CIs) were determined for dogs with radiographs classified as LIV and LSV. RESULTS: TPAs did not change from 90 days of age to physeal closure. Mean age for dogs with radiographs classified as LIV was 70.2 days (95% CI, 68.12 to 72.28 days), with no dog with LIV radiographs over 81 days of age. Mean age for dogs with radiographs classified as LSV was 85.5 days (CI, 76.73 to 94.27 days). CONCLUSIONS AND CLINICAL RELEVANCE: TPAs in Labrador Retrievers and Labrador Retriever-hound crossbreeds can be measured accurately after 90 days of age, and earlier attempts to measure result in falsely low TPA measurements. Measuring TPAs in growing dogs may allow earlier detection of premature physeal closures. As more is learned about the role of theTPA in cranial cruciate ligament injury, early treatment may be possible for growing dogs with cruciate ligament injuries and excessive tibial slope.     

Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

OBJECTIVE: To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. PROCEDURE: Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. RESULTS: 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. CLINICAL IMPLICATIONS: The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.     

Ferrets: wound healing and therapy.

In all species of mammals, the stages of wound healing are the same, and both host factors and wound characteristics affect how wounds heal. The basic principles of wound care in ferrets, such as lavage, bandaging, and surgical closure, are similar to those in other species; however, knowledge of ferrets' anatomy and pathophysiology, as well as skin conditions commonly seen in ferrets, will help ensure proper wound healing.     

Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.     

Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba

OBJECTIVE: To determine the bursting strength of ventral median abdominal incisions closed by either simple continuous or inverted cruciate suture patterns. STUDY DESIGN: Experimental. ANIMAL OR SAMPLE POPULATION: Twelve equine cadavers. METHODS: A 25 cm ventral median incision was made through the linea alba and a 200 L polyurethane bladder was placed within the abdomen. Either a simple continuous or an inverted cruciate pattern using 3 polyglactin 910 with a bite size and suture interval of 1.5 cm was used to close linea incisions. Closure time was recorded for each pattern. The bladder was inflated with air at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and the wound failure modes were recorded. Deviation from the linea (cm), total suture length (cm), suture length to wound length ratio (SL:WL), closure time (min), bursting pressure (mm Hg), and failure modes were compared between groups using Welch-Aspin t-tests. The effects of independent subject variables were assessed for possible effects on bursting strength using analysis of covariance. RESULTS: Mean bursting pressure was significantly greater for the simple continuous pattern than for the inverted cruciate pattern (P = .01). Significantly less suture material (P = .0002) was required with the continuous pattern than with the inverted cruciate pattern. Mean closure time, SL:WL, deviation from the linea, and failure modes were not significantly different between groups. No significant effects were noted for independent variables in both groups on bursting strength. CONCLUSIONS: In this model, a simple continuous closure pattern for ventral median abdominal incisions was stronger than an inverted cruciate pattern. A simple continuous pattern leaves less foreign material in the wound, which may be of benefit in reducing incisional complications. CLINICAL RELEVANCE: Use of a continuous closure pattern for the linea alba may offer greater wound security during episodes of increased intra-abdominal pressure in horses.